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OwnerL <br />�/ <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Job Address �%�� ,_C�%Cln��_�-� (�(L�-� Permit No. mf yQ� '_d� <br />The refrigerant line � natural P/ medical gas system (circle one) was tested at� psi for a <br />total of �. � minutes. � <br />,� <br />WITNESSED BY � _ ��,(j __ Date ,��1 ��f�5 _. <br />--n,r: ii�lo�,occc.ar)t� �.quesun gas s �_rvicy � - - <br />L � �I/-tB.S �(% /.�/" �-�' - <br />INSTALLED BY ,��i� /�""'"� Date � 1—=1 � � - <br />( qnature al in;�al'in� qa9�{te <br />Please arr��ge for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />' REFRIGERFNT CONTAINING PARTS OF THE SYSTEFd THAT IS RELD ERECTED SHALL BE TESTED FOR LEAKS /1T T[S7 PH[SSURFS NOT <br />LESS TNAN THE LOWER OF THE DESIGN PR@SSURES OR TH[ SETTING OF THE PRESSURE FELIEF DEVIG[S. THE DESIGN PRESSURE <br />FOR TESTING SH�LL BE 7HOSE USTED ON 7HE CONDENSING UNIT OR C01.1PRESSOR UNIT NAIdE PLqTE (WAC 51�»2�1108) <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />awPTa �sn;i <br />